Provider Demographics
NPI:1689768756
Name:BUSSCHER, ROSELYN (PSYD LP)
Entity Type:Individual
Prefix:DR
First Name:ROSELYN
Middle Name:
Last Name:BUSSCHER
Suffix:
Gender:F
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 160TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8348
Mailing Address - Country:US
Mailing Address - Phone:952-898-1133
Mailing Address - Fax:952-435-6797
Practice Address - Street 1:7580 160TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8348
Practice Address - Country:US
Practice Address - Phone:952-898-1133
Practice Address - Fax:952-435-6797
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 0472103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN489748000Medicaid
MN680000753Medicare ID - Type Unspecified
MN116188Medicare UPIN